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Muniyapillai T, Kulothungan K, Aswin A, R A, G G, Z HK, M HB, B H. Effect of Self-Care Activities and Behaviors on Glycemic Control in Patients With Diabetes at a Tertiary Care Hospital in Perambalur, South India: A Cross-Sectional Study. Cureus 2024; 16:e52188. [PMID: 38348008 PMCID: PMC10859554 DOI: 10.7759/cureus.52188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
Background The complications of type 2 diabetes mellitus (T2DM) continue to cause significant morbidity and mortality, resulting in a substantial economic burden on both individual patients and society. The adoption of self-care practices leads to enhanced glycemic control, decreased complications, and an elevated quality of life. This study aimed to examine self-care activities and their association with glycemic control among individuals with diabetes. Materials and methods A cross-sectional study was conducted, involving 150 previously diagnosed T2DM patients who visited the tertiary care hospital in Perambalur, Tamilnadu, India, from March 2023 to May 2023. The collection of data involved conducting a semi-structured interview using the diabetes self-management questionnaire (DSMQ) over an eight-week period. Following the input of the data into MS Excel (Microsoft® Corp., Redmond, WA), SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp) was used for data analysis. Results The mean age of the patients was 58.35±11.97 years, and 54.7% (n=82) of them were male. Nearly 65% of diabetic patients (n=98) were on orally administered antihyperglycemic agents. Fifty-nine percent (n=89) of the patients were observed to possess self-care behaviors that met the criteria for adequacy, as the DSMQ scores were dichotomized into "adequate" (≥6) and "inadequate" (<6) categories. We observed that 65% (n=98) of the patients had uncontrolled T2DM, characterized by an HbA1C level above 7.5%. Out of the four subscales of self-care behaviors assessed in this study, "glucose management" scored the highest (5.27±1.30), followed by "dietary control" (5.09±1.53), "healthcare use" (4.86±1.50), and "physical activity" (3.27±1.42). The proportion of diabetic patients who had adequate self-management (55%, n=49) had better glycemic control compared to diabetic patients who had inadequate self-management (4.91%, n=3), and this difference in proportion was statistically significant by the chi-square test (p-value 0.001). Similarly, a statistically significant association was noted between glycemic control and the subscales of DSMQ, namely glucose management, dietary control, physical activity, and healthcare utilization. Conclusion The findings in this study indicate that a noticeable proportion of T2DM patients practice inadequate self-care behaviors. According to the DSMQ, diabetic patients with adequate self-management had better glycemic control than diabetic patients with inadequate self-management. According to this research, patients with good glycemic control also tend to exercise better self-care management and show a greater concern for their illness.
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Affiliation(s)
| | | | - A Aswin
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | - Abinaya R
- Community Medicine, Panimalar Medical College Hospital and Research Institute, Chennai, IND
| | - Guruvenkat G
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | - Hafeeza Kulthum Z
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | - Hajira Beevi M
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | - Harigovindh B
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
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Kamarli Altun H, Özyildirim C, Koç Ş, Aksoy HN, Sağir B, Bozkurt MS, Karasu H. The factors associated with orthorexia nervosa in type 2 diabetes and their effect on diabetes self-management scores. Eat Weight Disord 2023; 28:22. [PMID: 36809582 PMCID: PMC9944002 DOI: 10.1007/s40519-023-01552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE This study aimed to determine the factors affecting the ORTO-R scores in individuals with T2DM and to investigate their effect on diabetes self-management. METHODS The study included 373 individuals with type 2 diabetes between the ages of 18-65 who applied to Akdeniz University Hospital Endocrinology and Metabolic Diseases Polyclinic between January and May 2022. A questionnaire including sociodemographic data, information about diabetes, and nutritional habits, and the ORTO-R and Type 2 Diabetes Self-Management Scales were used to collect data. Linear regression analysis was performed to determine the factors affecting ORTO-R. RESULTS The linear regression analysis showed that age, gender, education level, and duration of diabetes affected ORTO-R scores in patients with type 2 diabetes. Body mass index, comorbidities (cardiovascular diseases, kidney diseases and hypertension), diabetes-related complications, diabetes treatment method and dieting had no significant contribution to the model (p > 0.05). We also found that education level, comorbidities, diabetes-related complications, diabetes treatment method, dieting, and BMI can affect diabetes self-management. CONCLUSION It should be kept in mind that type 2 diabetes are at risk of orthorexia nervosa (ON) in terms of various aspects such as age, gender, education level and duration of diabetes. Since the factors affecting the risk of ON and the factors affecting diabetes self-management are intertwined, orthorexic tendencies should be kept under control while trying to increase self-management in these patients. In this respect, developing individual recommendations according to the psychosocial characteristics of patients may be an effective approach. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Affiliation(s)
- Hülya Kamarli Altun
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Caner Özyildirim
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye.
| | - Şeyma Koç
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Hatice Nur Aksoy
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Beyza Sağir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Merve Sefa Bozkurt
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Hakan Karasu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
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Heiran A, Azarchehry SP, Dehghankhalili S, Afarid M, Shaabani S, Mirahmadizadeh A. Prevalence of diabetic retinopathy in the Eastern Mediterranean Region: a systematic review and meta-analysis. J Int Med Res 2022; 50:3000605221117134. [PMID: 36314851 PMCID: PMC9629581 DOI: 10.1177/03000605221117134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives Individual studies in the Eastern Mediterranean Region (EMR) have shown the high prevalence of diabetic retinopathy. We conducted a meta-analysis to yield an estimate of the prevalence of diabetic (type 1 and 2) retinopathy in the EMR. Additionally, we explored its potential modulators. Methods Two-step screening of relevant articles published from 1 January 2000 to 13 December 2019 was carried out. An estimation of summary proportions, subgroup analysis, meta-regression, and publication bias assessment were performed. Results One hundred nine articles were included in the meta-analysis, involving 280,566 patients. The prevalence of diabetic retinopathy was 31% (95% confidence interval [CI] = 28, 33). The highest and lowest diabetic retinopathy prevalence rates were observed in low human development index (HDI) countries (63.6; 95% CI = 52.4, 74.0) and very high HDI countries 22.6 (95% CI = 20.5, 24.7), respectively. Conclusions The prevalence of diabetic retinopathy is high in the EMR. Our results provide important information for diverse healthcare surveillance systems in the EMR to implement the modifiable risk factors, diabetes screening to decrease undiagnosed diabetes, early detection of retinopathy, and proper diabetes care to decrease untreated diabetes.
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Affiliation(s)
- Alireza Heiran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Alireza Mirahmadizadeh, Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Zand Blvd, Shiraz, Iran. PO: 7193635899.
| | - Seyede Pegah Azarchehry
- Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Mehrdad Afarid
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sonia Shaabani
- Alzahra Cardiovascular Charitable Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Letta S, Aga F, Yadeta TA, Geda B, Dessie Y. Poor Self-Care Practices and Being Urban Resident Strongly Predict Chronic Complications Among Patients with Type 2 Diabetes in Eastern Ethiopia: A Hospital-Based Cross-Sectional Study. Diabetes Metab Syndr Obes 2022; 15:2095-2106. [PMID: 35898445 PMCID: PMC9309320 DOI: 10.2147/dmso.s368165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diabetes, together with its complications, has a considerable negative influence on people's quality of life and healthcare delivery and raises diabetic mortality. However, there is limited information about the diabetes-associated chronic complications in the study setting. Therefore, this study aimed to determine the burden and factors related to the chronic complications among patients with type 2 diabetes (T2D) in Eastern Ethiopia. METHODS A hospital-based cross-sectional study was conducted among 879 patients with T2D at two public hospitals in Harar. The data were collected through interviews using a structured questionnaire. Data related to the diagnosis of chronic complications and biochemical tests were extracted from medical records. The outcome variable was the number of chronic complications that happened to the patients. A generalized Poisson regression model with robust variance estimation was used to investigate the association of independent variables with chronic complications. An adjusted prevalence ratio with a 95% CI was reported to show an association using a p-value ≤0.05. RESULTS One or more chronic complications were presented in 43% of T2D (95% CI: 39.65, 46.19). Macrovascular and microvascular complications were found in 27.6% and 23.5% of patients, respectively. Urban residence (APR = 2.64; 95% CI: 1.54, 4.54), low wealth status (APR = 1.80; 95% CI: 1.17, 2.76), diabetes duration ≥5 years (APR = 1.46; 95% CI: 1.05, 2.01), hypertriglyceridemia (APR = 1.48; 95% CI: 1.07, 2.09) and poor self-care practices (APR = 1.62; 95% CI: 1.18, 2.23) were factors significantly associated with the chronic complications. CONCLUSION The burden of chronic complications was high, with nearly half of T2D patients experiencing one or more chronic complications. Almost one in ten patients suffered from multiple chronic complications. The complications were mainly influenced by being urban resident, low wealth status, and poor self-care practices. Therefore, health care providers need to educate patients and promote self-care practices and healthy lifestyles to achieve treatment goals and lower the risk of chronic complications.
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Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Correspondence: Shiferaw Letta, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Tel +251911771934, Email
| | - Fekadu Aga
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Enggarwati P, Dahlia D, Maria R. Social support as a mediator between depressive symptoms and self-care activities in adults patient with type 2 diabetes mellitus. J Public Health Res 2021; 11. [PMID: 35255669 PMCID: PMC8958446 DOI: 10.4081/jphr.2021.2734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People with type 2 DM are at risk of experiencing depression, which in turn can affect their self-care activities. Recent evidence has shown that social support is beneficial in reducing the risk of depression and positively affecting increases in self-care activities. However, the role of social support in the relationship between depressive symptoms and self-care activities has not been studied. This study aims to determine the mediating effects of social support on the relationship between depressive symptoms and self-care activities of people with type 2 DM. DESIGN AND METHODS A cross-sectional consecutive sampling approach was used with 94 respondents with type 2 diabetes in East Jakarta, Indonesia, who were undergoing diabetes treatments during May-June 2020. The instruments used were the Centre for Epidemiologic Studies-Depression Scale (CES-D), Summary of Diabetes Self Care Activities (SDSCA), and Duke-UNC Functional Social Support Questionnaire (DUFSSQ). All three questionnaires have been tested for validity and reliability. Data analysis was carried out using multiple linear regression, path analysis, and the Sobel test. RESULTS The results of multiple linear regression analysis on the variables age, sex, education level, socioeconomic status, duration of type 2 DM, and complications of type 2 DM showed that only complications of type 2 diabetes affected self-care activities (p = 0,000; R2 = 0.515). The results of the path analysis and Sobel test showed that social support significantly mediated the effects of the relationship between depressive symptoms and self-care activities (z = -0,162 > table 1.96; direct effect = -0,499; indirect effect = -0,0789; total effect = 40, 3%). CONCLUSIONS Screening for depressive symptoms and interventions involving social support are strongly suggested for patients with type 2 DM who are suspected of showing a decline in self-care activities.
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Affiliation(s)
| | | | - Riri Maria
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java.
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Świątoniowska-Lonc N, Tański W, Polański J, Jankowska-Polańska B, Mazur G. Psychosocial Determinants of Treatment Adherence in Patients with Type 2 Diabetes - A Review. Diabetes Metab Syndr Obes 2021; 14:2701-2715. [PMID: 34163198 PMCID: PMC8215904 DOI: 10.2147/dmso.s308322] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/30/2021] [Indexed: 12/18/2022] Open
Abstract
Less than 50% of patients with diabetes achieve the glycaemic goals recommended by the American Diabetes Association. The set of factors associated with adherence to treatment is very broad. Evidence suggests that psychosocial factors are related to medication adherence of patients with type 2 diabetes. Due to the lack of a clear statement from researchers regarding the relationship of psychosocial factors to adherence, an electronic search was conducted in PubMed, MEDLINE, Academic Search Ultimate, CINAHL Complete, Edition and Health Source: Nursing/Academic Edition using the following keywords "adherence", "diabetes", "social support", "stress", "anxiety and depression", "beliefs about medicine", "communication", "older age", "frailty", "cognitive impairment", "addiction", "acceptance of illness", "sense of coherence" obtaining 2758 results. After a narrowing of searches and reference scanning, 36 studies were qualified. The studies analysed showed negative effects of anxiety, diabetes distress, older age, poor communication with physicians, stress, concerns about medicines and cognitive impairment on levels of self-care and medication adherence. One study did not confirm the association of depression with adherence. Self-efficacy, social and family support, and acceptance of illness had a beneficial effect on medication adherence. In conclusion, the current evidence suggests that the relationship between psychosocial factors and adherence has reliable scientific support.
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Affiliation(s)
| | - Wojciech Tański
- Department of Internal Medicine, 4th Military Teaching Hospital, Wrocław, Poland
| | - Jacek Polański
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wrocław, Poland
| | | | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wrocław, Poland
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Alruhaim HY, Almigbal TH, Almutairi JS, Mujammami MH, AlMogbel TA, Alrasheed AA, Al Zahrani AM, Batais MA. The association between diabetes numeracy and diabetes self-management among Saudi adults with insulin-treated diabetes. Saudi Med J 2021; 42:517-525. [PMID: 33896781 PMCID: PMC9149690 DOI: 10.15537/smj.2021.42.5.20200422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To describe the association between diabetes numeracy and diabetes self-management among Saudi adults with insulin-treated diabetes. METHODS From August 2018 to January 2019, a cross-sectional study was conducted in 3 diabetes centers in Riyadh, Buraydah, and Jeddah, Saudi Arabia. Systematic random sampling was used to include 290 Saudi adults with insulin-treated diabetes. The levels of diabetes numeracy and diabetes self-management were measured by using the Diabetes Numeracy Test tool (DNT-15) and Diabetes Self-Management Questionnaire tool (DSMQ). RESULTS The final analysis included 279 completed surveys. The mean total score of DSMQ was 6.47. The total DSMQ score was higher among patients who had a lower level of education (p=0.02), and patients who had a higher level of diabetes knowledge (p=0.01). The mean total score of DNT-15 was 41.3%. Patients who had lower diabetes numeracy scores tended to be younger, married, have fewer years of education, have a lower monthly income(p<0.001), use insulin only, and have type 1 diabetes. Patients who achieved a total score of 82%, and higher in DNT-15 have also achieved the highest score in DSMQ (p=0.17). A linear regression analysis adjusted for level of education, diabetes knowledge, and other variables found a modest association between low diabetes numeracy and low diabetes self-management (p=0.08). CONCLUSION Lower level of diabetes numeracy was associated with lower level of diabetes self-management.
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Affiliation(s)
- Hiba Y. Alruhaim
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Turky H. Almigbal
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Joud S. Almutairi
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Muhammad H. Mujammami
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Turki A. AlMogbel
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Abdullah A. Alrasheed
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Abdullah M. Al Zahrani
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Mohammed A. Batais
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
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Yu ES, Hong K, Chun BC. Incidence and risk factors of vascular complications in people with impaired fasting glucose: a national cohort study in Korea. Sci Rep 2020; 10:19504. [PMID: 33177611 PMCID: PMC7659344 DOI: 10.1038/s41598-020-76661-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/02/2020] [Indexed: 12/22/2022] Open
Abstract
This study aimed to evaluate the risk of vascular complications of impaired fasting glucose (IFG). This population-based study included 425,608 participants from the National Health Screening Cohort in Korea in 2003 and 2004 who were followed-up until 2015. The participants were classified into normal, IFG, and diabetes groups based on fasting plasma glucose levels. Incidence rate (per 1000 person-year) was evaluated for the following vascular complications: cardiovascular (ischemic heart disease, cerebrovascular disease, arterial and capillary disease), renal, and retinal diseases. Hazard ratios (HR) of IFG for diabetes were estimated after adjusting for patient characteristics. Among the 88,330 IFG participants, the incidence of cardiovascular, chronic renal and retinal diseases were 11.52, 0.47, and 1.08 per 1000 person-years, respectively. Furthermore, IFG patients with a family history of diabetes, past history of hypertension, and high body mass index had significantly increased risk of vascular complications [adjusted HR, cardiovascular: 1.39 (95% CI 1.33–1.46); renal: 2.17 (95% CI 1.66–2.83); and retinal: 1.14 (95% CI 0.98–1.32)]. IFG patients have a substantial risk of cardiovascular, chronic renal and retinal diseases. Therefore, early preventative interventions are beneficial, especially for those with high-risk factors, in whom should emphasize on maintaining a healthy lifestyle, early screening and continuous follow-up.
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Affiliation(s)
- Eun Sun Yu
- National Health Insurance Service, Wonju-si, South Korea.,Korea University Graduate School of Public Health, Seoul, South Korea
| | - Kwan Hong
- Korea University Graduate School of Public Health, Seoul, South Korea.,Department of Preventive Medicine, Korea University College of Medicine, Seoul, 02841, South Korea
| | - Byung Chul Chun
- Korea University Graduate School of Public Health, Seoul, South Korea. .,Department of Preventive Medicine, Korea University College of Medicine, Seoul, 02841, South Korea.
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Vincze A, Losonczi A, Stauder A. The validity of the diabetes self-management questionnaire (DSMQ) in Hungarian patients with type 2 diabetes. Health Qual Life Outcomes 2020; 18:344. [PMID: 33076906 PMCID: PMC7574306 DOI: 10.1186/s12955-020-01595-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A wide range of measuring instruments are available for diabetes self-management. According to several studies, a relatively new instrument, the diabetes self-management questionnaire (DSMQ), shows a consistent relationship with outcomes of diabetes treatment as well, such as glycated hemoglobin (HbA1c). Furthermore, the questionnaire is short, but covers the main aspects of diabetes management. Given the increasing prevalence of diabetes in Hungary, our goal was to adapt this user-friendly questionnaire and analyze its validity. METHODS After the standard translation process, we analyzed a sample of 221 people. The construct validity of the questionnaire was tested with HbA1c and body mass index. Morisky Medication Adherence Scale-8 values were tested via Pearson correlations. Known-groups validity of the DSMQ in relation to groups based on glycemic control levels was investigated using one-way ANOVA. RESULTS The "sum scale" of the questionnaire and the HbA1c values show an inverse relationship (r = - 0.253, p < 0.01). Body mass index was related to the "sum scale" (r = - 0.214, p < 0.01) and to the "physical activity" (r = - 0.219, p < 0.01), while questionnaire results reflecting medication adherence correlated with the "glucose management" (r = - 0.291, p < 0.01), "health-care use" subscale (r = 0.236, p < 0.01) and the "sum scale" (r = 0.281, p < 0.01). A significant difference (F = 6.225, p = 0.002) was found between the DSMQ mean scores of the three groups, defined by good, medium, and poor glycemic control levels. CONCLUSIONS The Hungarian version of the DSMQ was considered a valid tool for the measurement of diabetes self-management. With its help, problematic areas of self-management could be uncovered, and interventions can be improved.
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Affiliation(s)
- Agnes Vincze
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi S. str. 2/a, Budapest, 1083, Hungary.
| | - Antonia Losonczi
- Faculty of Education and Psychology, Eötvös Lorand University, Budapest, Hungary
| | - Adrienne Stauder
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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10
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Choi SE, Roy B, Freeby M, Mullur R, Woo MA, Kumar R. Prefrontal cortex brain damage and glycemic control in patients with type 2 diabetes. J Diabetes 2020; 12:465-473. [PMID: 31886635 PMCID: PMC7210044 DOI: 10.1111/1753-0407.13019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/25/2019] [Accepted: 12/26/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study examined brain tissue integrity in sites that controls cognition (prefrontal cortices; PFC) and its relationships to glycemic outcomes in adults with type 2 diabetes mellitus (T2DM). METHODS We examined 28 T2DM patients (median age 57.1 years; median body mass index [BMI] 30.6 kg/m2 ;11 males) and 47 healthy controls (median age 55.0 years; median BMI 25.8 kg/m2 ; 29 males) for cognition (Montreal Cognitive Assessment [MoCA]), glycemic control (hemoglobin A1c [HbA1c]), and PFC tissue status via brain magnetic resonance imaging (MRI). High-resolution T1-weighted images were collected using a 3.0-Tesla MRI scanner, and PFC tissue changes (tissue density) were examined with voxel-based morphometry procedures. RESULTS Reduced PFC density values were observed in T2DM patients compared to controls (left, 0.41 ± 0.02 mm3 /voxel vs 0.44 ± 0.02 mm3 /voxel, P < 0.001; right, 0.41 ± 0.03 mm3 /voxel vs 0.45 ± 0.02 mm3 /voxel, P < 0.001). PFC density values were positively correlated with cognition; left PFC region (r = 0.53, P = 0.005) and right PFC region (r = 0.56, P = 0.003), with age and sex as covariates. Significant negative correlations were found between PFC densities and HbA1c values; left PFC region (r = -0.39, P = 0.049) and right PFC region (r = -0.48, P = 0.01), with age and sex as covariates. CONCLUSIONS T2DM patients showed PFC brain tissue damage, which is associated with cognitive deficits and poor glycemic control. Further research is needed to identify causal relationships between HbA1c, cognition, and brain changes in T2DM and to evaluate the impact of interventions to prevent brain tissue injury or neuroregeneration in this high-risk patient population, to eventually preserve or enhance cognition and improve glucose outcomes.
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Affiliation(s)
- Sarah E Choi
- School of Nursing, University of California Los Angeles, Los Angeles, California
| | - Bhaswati Roy
- Department of Anesthesiology, David Geffen School of Medicine, Los Angeles, California
| | - Matthew Freeby
- Division of Endocrinology, Diabetes, & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Rashmi Mullur
- Division of Endocrinology, Diabetes, & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Mary A Woo
- School of Nursing, University of California Los Angeles, Los Angeles, California
| | - Rajesh Kumar
- Department of Anesthesiology, David Geffen School of Medicine, Los Angeles, California
- Radiological Sciences, University of California Los Angeles, Los Angeles, California
- Bioengineering, University of California Los Angeles, Los Angeles, California
- Brain Research Institute, University of California Los Angeles, Los Angeles, California
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11
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Association of Diabetes-related Emotional Distress with Diabetes Self-care and Glycemic Control among Adult Filipinos with Type 2 Diabetes Mellitus at a Tertiary Hospital in Manila, Philippines. J ASEAN Fed Endocr Soc 2019; 34:189-196. [PMID: 33442155 PMCID: PMC7784174 DOI: 10.15605/jafes.034.02.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/30/2019] [Indexed: 11/17/2022] Open
Abstract
Objective The study aims to determine the association of diabetes-related emotional distress with reported diabetes self-care, and glycemic control of adult Filipinos with type 2 diabetes mellitus at The Medical City using 2 psychometric tests. Methodology This is a cross-sectional study conducted among 94 Filipinos diagnosed with type 2 diabetes mellitus, who answered 2 validated English questionnaires: Problem areas in diabetes (PAID-20) and Diabetes self-management questionnaire (DSMQ) that screen for diabetes-related emotional distress and diabetes reported self-care, respectively. Data were encoded and analyzed using Stata SE v.13. Results 42.6% of Filipinos with type 2 diabetes mellitus had emotional distress showing moderate to severe distress in factor 1 (diabetes-related emotional distress) and factor 3 (food related problems). 51.1% had suboptimal self-care, poorly scoring in areas of health-care use and dietary control. Majority of those who had diabetes-related distress and poor self-care where young, pre-obese and had diabetes duration of ±5 years. There was no significant association between diabetes-related emotional distress with diabetes self-care and emotional distress with glycated hemoglobin, but majority of those who had diabetes distress had higher glycated hemoglobin. There was significant association between diabetes self-care and glycemic outcomes (p=0.006) with relative risk of 1.51 (95% CI 1.10-2.07). There was linear inverse weak correlation between all subdomains of DSMQ with glycated hemoglobin except Dietary Control. Conclusion Diabetes-related emotional distress and sub-optimal self-care are prevalent among Filipinos with type 2 diabetes mellitus. Those who had poor self-care were 1.5 times more likely to have poor glycemic outcomes.
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12
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Sadat Mahmoudi Nezhad G, Razeghinejad R, Janghorbani M, Mohamadian A, Hassan Jalalpour M, Bazdar S, Salehi A, Molavi Vardanjani H. Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis. J Ophthalmic Vis Res 2019; 14:321-335. [PMID: 31660112 PMCID: PMC6815336 DOI: 10.18502/jovr.v14i3.4790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/06/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose
To estimate the pooled prevalence and incidence of diabetic retinopathy (DR) in Iran and to investigate their correlations with the Human Development Index (HDI), healthcare access (i.e., density of specialists and sub-specialists), and methodological issues. Methods
Electronic databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and local databases were searched for cohort and cross-sectional studies published prior to January 2018. Prevalence and incidence rates of DR were extracted from January 2000 to December 2017 and random effects models were used to estimate pooled effect sizes. The Joanna Briggs Institute critical appraisal tool was applied for quality assessment of eligible studies. Results A total of 55,445 participants across 33 studies were included. The pooled prevalence (95% CI) of DR in diabetic clinics (22 studies), eye clinics (4 studies), and general population (7 studies) was 31.8% (24.5 to 39.2), 57.8% (50.2 to 65.3), and 29.6% (22.6 to 36.5), respectively. It was 7.4% (3.9 to 10.8) for proliferative DR and 7.1% (4.9 to 9.4) for clinically significant macular edema. The heterogeneity of individual estimates of prevalence was highly significant. HDI (P < 0.001), density of specialists (P = 0.004), subspecialists (P < 0.001), and sampling site (P = 0.041) were associated with heterogeneity after the adjustment for type of DR, duration of diabetes, study year, and proportion of diabetics with controlled HbA1C. Conclusion Human development and healthcare access were correlated with the prevalence of DR. Data were scarce on the prevalence of DR in less developed provinces. Participant recruitment in eye clinics might overestimate the prevalence of DR.
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Affiliation(s)
- Golnoush Sadat Mahmoudi Nezhad
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.,Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Mohsen Janghorbani
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Mohamadian
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Jalalpour
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somaye Bazdar
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Salehi
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Wen Z, Zou X, Xie X, Zheng S, Chen X, Zhu K, Dong S, Liang J, Huang X, Liu D, Wang Y, Liu Y, Wu J, Ying Y, Liu K, Lu C, Zhang B, Yang G, Jing C, Nie L. Association of Polymorphisms in miRNA Processing Genes With Type 2 Diabetes Mellitus and Its Vascular Complications in a Southern Chinese Population. Front Endocrinol (Lausanne) 2019; 10:461. [PMID: 31354628 PMCID: PMC6639830 DOI: 10.3389/fendo.2019.00461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/25/2019] [Indexed: 01/12/2023] Open
Abstract
Objective: To evaluate the potential association between the genetic variants in miRNA processing genes (RAN, XPO5, DICER1, and TARBP2) and susceptibility to type 2 diabetes mellitus (T2DM) and its vascular complications, as well as to further investigate their interaction with environmental factors in type 2 diabetes. Methods: We conducted a case-control study in genotyping of five polymorphic loci, including RAN rs14035, XPO5 rs11077, DICER1 rs13078, DICER1 rs3742330, and TARBP2 rs784567, in miRNA processing genes to explore the risk factors for T2DM and diabetic vascular complications. Haplotype analyses, interactions of gene-gene and interactions of gene-environment were performed too. Results: We identified a 36% decreased risk of developing T2DM in individuals with the minor A allele in DICER1 rs13078 (OR: 0.64; 95%CI: 0.42-0.95; P: 0.026). The AA haplotype in DICER1 was also associated with a protective effect on T2DM compared with the AT haplotype (OR: 0.63; 95%CI: 0.42-0.94; P-value: 0.023). T2DM patients with the TT+TC genotype at RAN rs14035 had a 1.89-fold higher risk of developing macrovascular complications than patients with the CC genotype (OR: 1.89; 95%CI: 1.04-3.45; P-value: 0.037). We also identified two three-factor interaction models. One is a three-factor [DICER1 rs13078, body mass index (BMI), and triglyceride (TG)] interaction model for T2DM (OR: 5.93; 95%CI: 1.25-28.26; P = 0.025). Another three-factor [RAN rs14035, hypertension (HP), and duration of T2DM (DOD)] interaction model was found for macrovascular complications of T2DM (OR = 41.60, 95%CI = 11.75-147.35, P < 0.001). Conclusion: Our study provides new evidence that two single nucleotide polymorphisms (SNPs) of the miRNA processing genes, DICER1 and RAN, and their interactions with certain environmental factors might contribute to the risk of T2DM and its vascular complications in the southern Chinese population.
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Affiliation(s)
- Zihao Wen
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Xiaoqian Zou
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Xin Xie
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Shaoling Zheng
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Xiaojing Chen
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Kehui Zhu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Shirui Dong
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Jiayu Liang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Xiuxia Huang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Dandan Liu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Yao Wang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Yumei Liu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Jing Wu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Yuting Ying
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Kailiang Liu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Congying Lu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Baohuan Zhang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Guang Yang
- Department of Pathogen Biology, School of Medicine, Jinan University, Guangzhou, China
- Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, China
- *Correspondence: Guang Yang
| | - Chunxia Jing
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
- Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, China
- Chunxia Jing
| | - Lihong Nie
- Department of Endocrine, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Lihong Nie
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14
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Bukhsh A, Lee SWH, Pusparajah P, Schmitt A, Khan TM. Psychometric properties of the Diabetes Self-Management Questionnaire (DSMQ) in Urdu. Health Qual Life Outcomes 2017; 15:200. [PMID: 29025432 PMCID: PMC5639758 DOI: 10.1186/s12955-017-0776-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/02/2017] [Indexed: 11/23/2022] Open
Abstract
Background Numerous study tools on diabetes self-care have been introduced; however, most existing tools do not show expectable and meaningful correlations with patients’ glycaemic control. The Diabetes Self-Management Questionnaire (DSMQ) was designed to appraise self-care activities which can predict glycaemic control outcomes. However, this tool has not been validated in Pakistan. Therefore, the aim of this study was to translate and examine the psychometric properties of the Urdu version of DSMQ among type 2 diabetes patients. Method Standard forward-backward translation was used to translate the DSMQ into Urdu language. A convenience sample of 130 patients with type 2 diabetes was collected to assess the Urdu version’s psychometric properties. Reliability was assessed by Cronbach’s coefficient α and validity was assessed using confirmatory factor analysis and criterion-related correlations. Results High internal consistency was found for all DSMQ scales (Sum scale: α = 0.96, Glucose Management: 0.91; Dietary Control: 0.88; Physical Activity: 0.89; Health-Care Use: 0.73). The DSMQ subscales showed significant correlations with HbA1c (Glucose Management: −0.75; Dietary Control: −0.76; Physical Activity: −0.71; Health-Care Use: −0.64; Sum Scale: −0.78; all p < 0.001). However, when associations with HbA1c were assessed in one multiple linear regression model, only Glucose Management and Dietary Control were significantly associated with lower HbA1c values (Beta = −0.42, p = 0.004 and Beta = −0.30, p = 0.028, respectively), while Physical Activity and Health-Care Use were not (p > 0.05). Adequate fit to the data was achieved for single factor model after successively modelling all significant correlations between the items’ error terms, with Chi2 = 106.6, df = 84, p = 0.049; TLI = 0.98, CFI = 0.99 and RMSEA = 0.05 (90% CI 0.01–0.07). Whereas a comparatively lower fit indices to data were observed in case of four factor model. Conclusion The findings support the Urdu version of the DSMQ as a reliable and valid instrument for assessing self-care activities associated with glycaemic control in type 2 diabetes patients. Electronic supplementary material The online version of this article (10.1186/s12955-017-0776-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia. .,Institute of Pharmaceutical Sciences, University of Veterinary & Animal Sciences, 54000, Lahore, Pakistan.
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Priyia Pusparajah
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), German Diabetes Center Mergentheim, Theodor-Klotzbücher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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